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NPI Code Detail

MEDICARE: LYNNE DIANE OLSEN OTR/L

MEDICARE: LYNNE DIANE OLSEN OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist288NE
2225X00000XOccupational Therapist00573IA
3225X00000XOccupational Therapist0556SD

General Provider Information

NPI Number : 1093094666
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNNE DIANE OLSEN OTR/L
Provider Business Mailing Address
First Line : 4525 PETERS AVE
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-1939
Country : US
Telephone Number : 712-276-7306
Fax Number :
Provider Business Practice Location Address
First Line : 3501 DAKOTA AVE
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3641
Country : US
Telephone Number : 402-494-3440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2011
Last Update Date : 08/12/2011

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Directions to “ LYNNE DIANE OLSEN OTR/L” Practice Location

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